Despite gratifying improvements in the diagnosis and treatments of congenital heart disease during the past fifty years, the 'state of the art' remains far from perfect. As summarized in the "Report of the Task Force on Children and Youth" (Moller et al., circulation 88:2479- 2486,1993), more than 600,000 children in the United States have some form of cardiac abnormality of congenital origin. The annual cost, in direct medical care expenses and lost contribution to the gross national product, is over $8 billion. With these concerns in mind we present a comprehensive program to train pediatric cardiology into the twenty- first century. The training program described in this proposal synergistically combines the laboratory resources of the Division of Pediatric Cardiology (and its recently initiated South Carolina Program in the Genetics of Cardiovascular Disease), the Cardiovascular Developmental Biology Center, and the Gazes Cardiac Research Institute at the Medical University of South Carolina. It is our goal to enroll two clinically trained fellows per year for a minimum of two continuous years of research training under mentors from these research units. A career planning element for transition to independence as researchers is an additional important element of our proposal. Recruitment of trainees for this opportunity will be aggressively pursued nationwide. However, only seventy trainees per year enter into clinical pediatric cardiology training programs in the USA; the number of trainees in the next few years is expected to drop below this number. We feel that the pool of pediatric cardiology-oriented researchers requires more manpower than the pool of pediatric cardiology trainees is likely to provide. We address this issue by expanding our program to include PhD postdoctoral trainees. We anticipate the enrollment of one PhD postdoctoral trainee every two years with the goal of initiating investigative careers complementary to the research needs of pediatric cardiology. We will recruit nationally for PhD postdoctoral trainees to enter a unique program providing formal multi-disciplinary exposure to the general clinical language and concerns of pediatric cardiology in addition to laboratory research activities. Through this program PhD postdoctoral trainees will be introduced to research questions central to the problems of cardiovascular disease in the young as well as provided the opportunities for interaction to communicate their advances to pediatric cardiologists for the ultimate benefit of children with congenital heart disease.